The goal of this proposal is to transform UTMB into a center of rigorous high quality comparative effectiveness research (CER) and patient-centered outcomes research (PCOR), focused on healthcare decision-making facing older individuals, their providers, and the health systems providing their care. Achieving this goal requires an institution-wide commitment to the following specific aims: 1) Establish structures for ongoing participation of key stakeholder groups and the larger community. 2) Training and education in PCOR of investigators, clinical leaders, providers, administrators & students. 3) Establish a robust infrastructure for sustainable growth and productivity in PCOR/CER. 4) Conduct rigorous PCOR relevant to aging. 5) Disseminate findings from PCOR/CER generated at UTMB and at other centers to the UTMB communities, and to stakeholders regionally and nationally. 6) Ongoing, active evaluation of all our efforts, to allow for modifications. The thematic research focus of this proposal is aging. Our planned programs will evaluate and compare healthcare delivery systems, as well as design, test and disseminate novel interventions to improve decision making. Important goals of this work are to include on-going input and collaboration with patients and other stakeholders, and to identify or develop systems that reduce racial, ethnic and age-associated disparities in health outcomes using patient-centered approaches. We have secured active partnership with key organizations and leaders within UTMB, including substantial institutional support for new faculty positions in PCOR. In addition, we are partnering with several established centers of excellence in key aspects of PCOR, including the Evidence-based Practice Centers at the University of Minnesota and Oregon, and the John M. Eisenberg Center for Clinical Decisions and Communication Sciences at Baylor. We will also partner with the other University of Texas Health Science campuses and regional health professions schools in disseminating PCOR.